Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates-Perspective for the Future.

Lars Mikael Broman

doi:10.3389/fped.2019.00329

Abstract

In recent years the number of extracorporeal membrane oxygenation (ECMO) cases in neonates has been relatively constant. Future expansion lays in new indications for treatment. Regionalization to high-volume ECMO centers allows for optimal utilization of resources, reduction in costs, morbidity, and mortality. Mobile ECMO services available “24-7” are needed to provide effective logistics and reliable infrastructure for patient safety. ECMO transports are usually high-risk and complex. To reduce complications during ECMO transport communication using time-out, checklists, and ECMO A-B-C are paramount in any size mobile program. Team members' education, clinical training, and experience are important. For continuing education, regular wet-lab training, and simulation practices in teams increase performance and confidence. In the future the artificial placenta for the extremely premature infant (23–28 gestational weeks) will be introduced. This will enforce the development and adaptation of ECMO devices and materials for increased biocompatibility to manage the high-risk prem-ECMO (28–34 weeks) patients. These methods will likely first be introduced at a few high-volume neonatal ECMO centers. The ECMO team brings bedside competence for assessment, cannulation, and commencement of therapy, followed by a safe transport to an experienced ECMO center. How transport algorithms for the artificial placentae will affect mobile ECMO is unclear. ECMO transport services in the newborn should firstly be an out-reach service led and provided by ELSO member centers that continuously report transport data to an expansion of the ELSO Registry to include transport quality follow-up and research. For future development and improvement follow-up and sharing of data are important.

Highlights

At the dawn of extracorporeal membrane oxygenation (ECMO) in the 1970s the neonatal population was the first group acknowledged to benefit from this new organ support [1]
In 1975 the alternative to transport the patient on conventional critical care support, i.e., to initiate ECMO at the referring hospital before transporting the patient was performed in a neonate [4]
The patient was transported on ECMO for continued support at an ECMO center [13, 14]

Summary

Introduction

At the dawn of extracorporeal membrane oxygenation (ECMO) in the 1970s the neonatal population was the first group acknowledged to benefit from this new organ support [1]. The number of hospitals which offered ECMO treatment was limited and the risk of transporting neonates on conventional respiratory support was considered high [2, 3]. As recently as a decade ago, only a small number of centers worldwide provided mobile ECMO services for bedside assessment and cannulae insertion. A transport preceded by bedside assessment, decision, and cannulation for ECMO by direct involvement of the transport team is defined as a primary transport [14, 15]. A secondary transport is a transfer of a patient already on ECMO, often for a day or more, i.e., the mobile team was not directly involved in the cannulation procedure

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Conclusion